Provider Demographics
NPI:1447790175
Name:LICE CLINIC OF AMERICA MURRAY
Entity type:Organization
Organization Name:LICE CLINIC OF AMERICA MURRAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTORINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-533-5423
Mailing Address - Street 1:154 E MYRTLE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-4849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:154 E MYRTLE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-4849
Practice Address - Country:US
Practice Address - Phone:801-533-5423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty